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The Business of Healthcare Data: The Value &
Return on Investment in Big Data Analytics
Session BG6, February 11, 2019
Kevin Meriwether, President, Conviva Care Solutions
Patrick Murta, Principal Solution Architect, Humana
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Kevin Meriwether
Patrick Murta
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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• Company overviews
– Humana
– Conviva Care Solutions
• Payer/Provider partnership
• Drivers changing the landscape
• Creating strategic data assets and full spectrum value
• Big Data focused on people, process, and workflow
• Using Big Data to support models in care and enable
organizational efficiencies
• Achieve ROI across the continuum
• Q/A
Agenda
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• Showcase an overarching business plan to create data and
value-driven business models
• Outline a Big Data program that reduces costs by focusing on
people, process, and workflow
• Leverage Big Data to support new models in care while enabling
organization to build efficiencies and reduce friction at the point
of care
• Highlight the Conviva approach to holistic value-based care
• Explore innovative methods to achieve ROI from both the
organizational and patient perspectives
Learning Objectives
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• Committed to helping our members achieve their best health through a spectrum of products and
offerings including insurance products, case management, population health, predictive analytics,
and well-being initiatives
• Sees integrated health delivery as the key in providing maximum benefit to our members and
partner providers
• Believes technology, including shared Big Data, is critical in achieving the goal of integrated care
delivery
• Closely partners with provider groups to enable the value based care and integrated care delivery
model
Humana is a leading insurer and health care
provider, with a focus on seniors
Insurance Services
Leading position in Medicare Advantage
(MA) and Part D
– 3.9 million
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MA members
– 4.5 million
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stand-alone Prescription Drug
Plan (PDP) members
One of the leading service providers to the
military through TRICARE contract
– 5.9 million
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members
1.5 million
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commercial group members
Healthcare Services
Humana At Home – approximately 716,000
members
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enrolled
Humana Pharmacy – 4th largest PBM
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/mail
order services
Primary Care Clinics – 233 owned, JV and
alliance clinics across 30 markets
Integrated Clinical & Consumer Analytics
platform
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• Conviva Care Solutions manages $2.2B in patient revenue,
serves 235,000 patients of which 79% are in full risk
arrangements
• Created as a joint venture between Humana & MCCI as an
independent and multi-payer care delivery organization
• Manages over 100 primary care medical centers in Florida and
Texas
• Employs 375 primary care clinicians in the Conviva Physician
Group and supports over 300 independent physician practices
• Conviva’s vision is to help people achieve their best lives
Conviva Care Solutions
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• Principal guideline: only through a provider/payer partnership can
we fully optimize patient care
• How this is achieved…
• Each focuses on core competencies
• Humana focuses on Big Data analytics and provides those
insights to Conviva
• Conviva takes the insights and optimizes patient care and
clinic operations
Partnership Model
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• Value Based Care has fundamentally changed the healthcare landscape
by tying data and analytics to desired health outcomes:
• Identification of at-risk populations and individuals
• Guidance on which actions or behavioral changes are needed to
achieve desired outcomes
• Predictive modeling of interventions
• Feedback on the results of those interventions
• Humana’s Big Data informs the mechanisms of risk stratification,
proactive solutions, appropriate hospitalization, appropriate utilization of
resources, and better quality of life
Value Based Care
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• Value based care drives the need for integration
• API/FHIR adoption is increasing
• 21
st
Century Cures Act is a lever to enable integration and
interoperability
• Industry initiatives such as Da Vinci and FAST are accelerating
the cause
• Blue Button 2.0 and other CMS and ONC support is moving
forward
• Need for innovation
Industry inflection point
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• Do you see value based care driving adoption of shared
analytics?
1. Yes, it’s necessary
2. No, not needed
3. Not sure yet
Poll Question 1
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• Payers have lots of data, both administrative and increasingly
clinical, to provide a more holistic view of the patient
• Payers typically have big computing infrastructures and Big Data
capabilities from both a compute stand point and data science
• Payers are willing to participate
• Clinicians who are experienced in Value Based Care provide
relevant insight to make payer data actionable
Why a payer / clinician partnership?
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• Distill Humana Big Data into usable insights for care delivery,
providing high value at the point of care for our clinicians and
patients
Plan for creating data with value – the goals
Humana
Big Data
Conviva
Clinical Data
Creation of
Care Plan
Implementation of
Care Plan
Intentional
Review
• Identify and treat the Right
Patient, at the Right Time, in the
Right Place, by the Right Care
Team
• In full-risk situations, every
interaction needs to be tied to
improved health outcomes
• Driving our investment in
minable data that is actionable
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• Humana has a wealth of data and synthesizes the information
from across the health care landscape
• Claims data includes touchpoints and interactions from across
the continuum of care – providing valuable insight for our Care
Teams to build personalized and holistic care plans
• Critical to this endeavor is proper Risk Stratification
• Stratification by clinical risk profile informs:
• Frequency of clinic visits
• Utilization of clinicians and specialist
• Referrals to specialty programs such as disease / pain
management and care coaching
The Conviva Model
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• Preventive testing and screening are optimized, addressing
HEDIS / quality gaps
• Insight into medication profiles allow clinicians to address
adherence and polypharamacy issues
• Insights from utilization across the continuum of care drive post-
acute management and transition of care planning
• Under-utilization patterns can also be identified, frequently
signaling social issues such as: Food Insecurity, Transportation,
and Care-giver Burnout, which can then be addressed
The Conviva Model
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The Conviva Model at Work
• Targeted primary prevention
• Flu Vaccination Program for high-risk patients
• Clinical pathways for special populations
• COPD optimization
• Optimized collaboration with specialists
• Pain management
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• How would you describe the term ‘Big Data’
1. Any large database
2. Marketing term
3. Specific tech such as Hadoop
Poll Question 2
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• Big Data is a combination of database technologies including
• Relational data models
• Hadoop
• Document data models
• NoSQL
• Big Data should be considered as one leg in a three legged stool
that consists of
• Big Data
• Workflow integration using contemporary technology such
as FHIR and SMART on FHIR
• People with right process
Key technical points
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• Do interoperability and data analytics compliment each other?
1. No relationship between them
2. Yes, definite synergy
3. Not sure yet
Poll Question 3
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Big Data Process
Live
Node
Model &
Discovery
Node
Data
Integration
Staging Bucket
Supported
Data
Subjects
Lab
Hedis
RX
HRA
Membership
BH
Claims
PM
MRA
Service Fund
Rewards
PHM
Census
Assessments
Care Plans
CCD
HL7
Unstructured
Data
Notes
Cases
Patient
Experience
Longitudinal
Ratings
E2
Data
Providers
Payers
PHM
Data Science
Normalizer
Metadata
Archiver
Mastering
Data
Foundation
Census
Programs
Financial
Indicators
Predictors
Insights
Quality
Patients
Visualization &
Integration
Modeling
Adapters and
Paths
Core Processes
API & Other
Distribution
FHIR Document Data Model
• ‘Future-proofing’
• No refactoring with versioning
• R and Python friendly for ML
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• Big Data acquisition and computing costs leveraged
• Clinician resource planning optimized
• Optimized clinical workflows and documentation
• Better health outcomes for our patients
Realizing ROI - Conviva
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• Healthy/happy members
• Decreased provider abrasion
• Better quality care
• Optimized outcomes and corresponding financial benefit
Realizing ROI - Humana
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• Living their best life
• More efficient interaction with clinicians
• Optimized use of their health care dollars
• Better engagement to community resources
Realizing ROI – Patients
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